Orthopaedic Advancements Enhance Quality of Life
By Sharon Miller, Communications Specialist
Baxter Regional Medical Center
Donna Nettles lived in excruciating pain for about two years before finding relief through an innovative hip resurfacing procedure being done by orthopaedic surgeon Dr. Tom Knox at Baxter Regional Medical Center.
The same surgery that allowed professional athlete Floyd Landis to return to competitive cycling allowed Nettles to enjoy life without constant pain. An alternative to total hip replacement known as Birmingham Hip Resurfacing helped them both.
“I feel like I literally have a new lease on life,” Nettles says. “I was pain-free right away. The day after surgery I could tell a difference.” Her hips were injured more than 30 years ago when she fell from a ladder and ended up in a “splits” position. The injury set her up for painful bone spurs and arthritis that developed over the years.
Although her pain grew progressively worse, it became “excruciating” about three years ago. As caregiver for her husband who was dying of leukemia, she couldn’t take time out for surgery. She continued working as a housekeeper at BRMC, but there were days she could barely keep going. She walked with a limp.
After her husband died about a year ago, she sought help for her own health issues. Knox thought she would be a good candidate for the hip resurfacing.
The procedure is recommended for patients younger than 60. “With older people, their bones are more fragile,” Knox explains. “You have to have good strong bones to carry this.”
In hip replacement surgery, the head and neck of the femur are removed and replaced with an artificial joint. The hip stem is inserted down the shaft of the femur. Hip resurfacing is less invasive. It requires the removal of only a few centimeters of bone and preserves both the femoral head and neck. A metal cup is then used to cap the joint, similar to a cap for a tooth.
The preservation of the bone’s natural structure and stability has made this surgery the choice for younger adults and for athletes such as Landis. Knox, himself an avid bicyclist, said a friend of his – a doctor and a cyclist – who had this surgery has gone on to bike as many as 500 miles in a weekend.
He said the longevity of these hips is expected to be more than a regular lifetime. “We hope this is a once-in-a-lifetime procedure,” he said.
Knox spent two weeks training in Alberta, Canada to learn this technique. And, working with medical devices company Smith and Nephew, Knox developed a new type of retractor so the procedure can be done through anterolateral (front and to one side) approach, his preferred method.
In the two years he has been using the Birmingham resurfacing, Knox has done 30 to 35 of the procedures at BRMC, all with good results. “Everyone we’ve done this with has returned to work,” he said.
Knee, shoulder techniques
Knox is also using innovative techniques to correct knee and shoulder problems. To reconstruct the ACL (anterior cruciate ligament), he is now using a method known as the “double bundle” technique. The ACL is one of four ligaments that connect the femur (thighbone) to the tibia (shinbone). Its natural state is to have two bundles, the anterior medial and the posterior lateral bundles, that stabilize both the side-to-side and backward/forward movement of the knee.
“In the past, we would try to accomplish both those things with one bundle,” Knox says. The ligament graft would go through one hole in the tibia and one hole in the femur.
“Now, we are making four separate holes, and we’re passing one ligament graft to recreate the anterior medial bundle, and then we’re passing another graft to recreate the posterior lateral bundle,” he said.
He trained for this procedure last fall in Jackson, Miss., and is seeing greater stability in patients who have had this type of repair. He said this should be especially beneficial for athletes.
Knox has been doing arthroscopic assisted ACL reconstructions for the past 26 years. But high definition arthroscopy equipment purchased by BRMC is enhancing the “double bundle” technique and other procedures.
Knox said he also uses the high definition equipment to do arthroscopic shoulder surgery, including rotator cuff repair and shoulder stabilization. “I’ve been doing arthroscopic rotator cuff repairs here for about four years,” Knox says. “Rather than making an incision opening the shoulder, we’re able to pass these sutures through the rotator cuff using small little implants called anchors.”
These “anchors” have sutures attached to them, and Knox can pass those through the rotator cuff, bring it back into place and suture it into the bone with the anchors, all while using the scope to guide him.
“From that, we are now doing complete stabilization of the shoulder,” he said. He used as an example a 17-year-old boy who kept having shoulder dislocations. To stabilize his shoulder, Knox was able to go in through four tiny holes, about a centimeter in diameter, insert the scope and use anchors with sutures. “They’re different anchors than what we use for a rotator cuff,” Knox explains. “We pass these anchors through and then pass the sutures through the capsule of the shoulder joint, recreating the natural ligaments the patient has, and tightening that up.”
The recovery time for the arthroscopic surgery is substantially less than that of surgery done with larger incisions. Knox said the 17-year-old would be in a sling for about four weeks letting the soft tissue envelope heal. He will start on motion exercises in about four weeks and be ready to return to sports if he wants to in about three to four months. With traditional surgery, it would likely be six to eight months before he could return to sports.
The goal of the new methods in orthopaedic surgery, Knox said, is to restore quality of life sooner and to help people retain the ability to participate in the activities they enjoy.
For more information about these and other procedures or to schedule an appointment, Knox can be reached at (870) 424-3400 |
